The pathogenesis of corticosteroid-induced osteoporosis is different from postmenopausal osteoporosis in that the major abnormality is a reduction in bone formation. Corticosteroids result in a 10–15% overall bone loss leading to an increased risk of fracture. Patients on corticosteroids also appear to fracture at a higher bone density than other postmenopausal women. It may therefore be appropriate to start treatment for osteoporosis in corticosteroid-treated patients at a higher bone density than for other postmenopausal women. The various treatments that have been employed are discussed, including calcium and vitamin D, calcitriol, hormone replacement therapy, bisphosphonates, calcitonin, anabolic steroids and fluoride salts. Bisphosphonates are the most extensively investigated treatments. The use of hormone replacement therapy should also be encouraged. The role of other treatments such as calcitriol, calcitonin and fluoride salts remains uncertain.
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